Form It-604 - Claim For Qeze Tax Reduction Credit - 2013 Page 4
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8Page 4 of 8 IT-604 (2013)
Schedule G – Beneficiary’s and fiduciary’s share of QEZE income
(see instructions)
A
B
C
Beneficiary’s name
Share of QEZE
Identifying number
(same as on Form IT‑205, Schedule C)
income
Total
.
00
.
00
.
00
Fiduciary
.
00
Schedule H – Related entities
List the names and EINs of any business entities related to the QEZE. Use additional sheets if necessary. Use the definition of related
persons in the instructions to determine if an entity is related.
Name
EIN
Schedule I – Valid business purpose for QEZEs first certified prior to August 1, 2002
(see instructions)
If you are claiming that the QEZE was formed for a valid business purpose, mark an X in the box and submit a
notarized statement describing in detail how your QEZE meets the valid business purpose test .....................................................
164004130094
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